Inspection·December 21, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, resident interview, and facility procedure review, the facility failed to ensure medications were ordered and available in a timely manner for newly admitted residents. This affected one (Resident #41) of three residents reviewed for timely medication administration. The census was 42. Findings Include: Review of the medical record for Resident #41 revealed she was admitted to the facility on [DATE]. Her diagnoses were chronic kidney disease (stage IV), spinal stenosis, weakness, need for assistance with personal care, difficulty walking, obstructive and reflux uropathy, schizophrenia, spondylosis, migraine, schizoaffective disorder, and major depressive disorder. Review of Resident #41's progress note dated 12/11/24 revealed she was admitted to the facility on [DATE] at approximately 8:14 P.M. Review of Resident #41's progress note dated 12/12/24 revealed information that some medications needed to be clarified with the physician and faxed to the pharmacy. The note also stated that the medications were drop shipped, which was expedited shipping from the pharmacy, so she could get all of her medications in the facility. Within the same note, the nurse documented that Resident #41's family was upset that the resident's medications had not been sent to the facility in a timely manner. Review of Resident #41 hospital discharge documents dated 12/11/24 revealed a comprehensive list of medications she was taking in the hospital, and then a comprehensive list of medications she was to take when she was admitted to the nursing facility. The medications listed to be ordered at the nursing facility included Tizanidine four milligrams (mg) three times daily for muscle spasms and Oxycodone five mg every six hours as needed with instructions to give one tablet for a pain level of one to four and two tablets for a pain level of five to ten (on a pain scale of zero to ten, zero indicating no pain and ten indicating the worst pain). Review of Resident #41's Medication Administration Records (MAR) for December 2024 revealed the following medications were unavailable and not included in the initial medication shipment on the morning of 12/12/24: Tizanidine four mg three times daily for muscle spasms (due at three separate ranges of time from 7:00 A.M. to 11:00 A.M., 1:00 P.M. to 2:30 P.M., and 7:00 P.M. to 11:00 P.M.) and Oxycodone five mg every six hours as needed with instructions to give one tablet for a pain level of one to four and two tablets for a pain level of five to ten. These medications were not shipped to the facility or administered to the resident until the afternoon of 12/12/24. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 366267 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366267 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Mayfield Village, Inc 290 North Commons Blvd Mayfield Village, OH 44143 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)